Hydatid liver cysts develop in the setting of an echinococcal infection, specifically E. granulosus and E. multilocularis. Signs and symptoms take years or decades after the introduction of this parasite into the human host. The diagnosis, in addition to clinical criteria, rests on imaging studies and microbiological investigations.
Echinococcosis is a term denoting an infection by E. granulosus (the causative agent of cystic echinococcosis) and E. multilocular (responsible for alveolar echinococcosis)   . Echinococci are small tapeworms (up to 7cm in diameter) that normally reside in several animal species - foxes and dogs serve as primary reservoirs, whereas sheep, goats, pigs (and several other ungulates) are intermediate hosts     . Human infection by this parasite is accidental and primarily occurs after ingestion of contaminated food products (including meat and vegetables) by egg-containing animal feces   . Once the parasite is in the human host, it slowly forms fluid-filled cysts, and the liver is the most common organ in which it establishes an infection    . As the formation of cysts is a very slow process (1mm-5mm in diameter per year), patients are asymptomatic for years or sometimes even decades  . Eventually, the enlarging cyst causes right upper quadrant abdominal pain, hepatomegaly, nausea, vomiting, increased pressure in the portal circulation (portal hypertension), cholestasis, biliary cirrhosis, and ascites, depending on their location and number, as 20-40% of patients develop multiple cysts   . In the absence of an early diagnosis, various complications can arise, most important and most dangerous being rupture of the cysts and subsequent anaphylactic reaction in the peritoneum, while secondary bacterial infections of the cysts and cholangitis are less commonly encountered   .
Entire Body System
Such a case is described and comprehensively illustrated in a 48-year-old immunocompromised man, presenting with upper abdominal pain, obstructive jaundice, and fever. [ncbi.nlm.nih.gov]
trench fever, human erlichiosis; and more. [books.google.de]
Polymicrobial - mostly enteric gram negatives and anaerobes, Staph and Strep (including Strep anginosus group - propensity for abscesses), Klebsiella pneumoniae (including hypermucoid strain), Candida (hepatosplenic candidiasis in recovered neutropenic fever [errolozdalga.com]
Patient and observation A fifty-year-old male with no special note of past or social history presented with high-grade fever and right hypochondrial pain of two week duration. [panafrican-med-journal.com]
Hernia 1257 Incisional Hernia Repair 1267 Uncommon Abdominal Wall Hernias 1275 Gastrointestinal Bleeding 1283 Upper Gastrointestinal Hemorrhage Diagnosis and Treatment 1285 Lower Gastrointestinal Bleeding 1297 Obscure Overt Gastrointestinal Bleeding [books.google.de]
Application of Sentinel Lymph Node Biopsy in Melanoma 1591 Surgical Treatment of Malignant Melanoma 1597 Surgical and Medical Management of Locally Advanced and Systemic Melanoma 1605 Soft Tissue Sarcomas of the Extremities and Chest Wall 1617 Endocrine 1629 Goiter [books.google.de]
Liver, Gall & Pancreas
Eventually, the enlarging cyst causes right upper quadrant abdominal pain, hepatomegaly, nausea, vomiting, increased pressure in the portal circulation (portal hypertension), cholestasis, biliary cirrhosis, and ascites, depending on their location and [symptoma.com]
The patient was jaundiced, febrile and had a tender hepatomegaly just below right costal. [panafrican-med-journal.com]
Hepatomegaly may be present or a mass may be felt. Tender hepatomegaly is a sign of secondary infection of the cyst, especially when coupled with fever and chills. Ascites is rare. [emedicine.medscape.com]
The diagnosis of hydatid liver cysts is often made incidentally, with the asymptomatic nature of the infection assuming to be the primary reason  . In addition, the global distribution of E. granulosus and the presence of E. multilocularis throughout the entire northern hemisphere (including North America, Russia and the majority of European countries) and the nonspecific clinical presentation, recognition of this pathogen solely on clinical criteria might not be easy . Nevertheless, a detailed patient history, including a thorough traveling history and assessment of animal exposure, is necessary during workup, as the infection is most prevalent in livestock-raising areas of the world  . After a meticulous physical examination is performed, imaging studies must be employed to confirm the diagnosis. Abdominal ultrasonography is usually the first step in the evaluation of abdominal symptoms, and it is an effective procedure in identifying the number, but also the size and diameter of the cysts     . As ultrasound is readily unable to differentiate between tumors, abscesses or cysts, however, the use of more advanced imaging methods is recommended, the first candidates being computed tomography (CT) and magnetic resonance imaging (MRI)    . Furthermore, fluorodeoxyglucose positron emission tomography (FDG-PET), contrast-enhanced ultrasonography, and diffuse-weighted imaging (DWI) might also be of use . Microbiological studies, on the other hand, in the form of antibody detection (serology) through western blot analysis, is also a vital step in distinguishing hydatid liver cysts from other pathologies, with very high sensitivity and specificity rates . Although a solid diagnosis is be made by fine-needle aspiration of the cysts and their fluid, the risk of rupture, dissemination, and/or anaphylaxis is often the major limitation for this procedure  .
OBJECTIVE: To report an 11-year experience of treatment of hydatid liver cysts with double percutaneous aspiration and injection of alcohol. [ncbi.nlm.nih.gov]
Although HLC represent a benign disease, treatment has to be considered mandatory in symptomatic cysts and recommended in viable cysts because of the risk of severe complications. [eurekaselect.com]
Abstract Percutaneous treatment has been developing as a reliable and effective alternative to surgery in the treatment of liver hydatid cysts. [ijri.org]
Percutaneous treatment of hydatid liver cysts in children as a primary treatment: long-term results. J Vasc Interv Radiol. 2005;16:831–9. Khuroo MS, Wani NA, Javid G,Khan BA, Yattoo GN, Shah AH,et al. [tropicalgastro.com]
With Cystic Echinococcosis, prognosis is good with surgical excision without spillage In Alveolar Echinococcosis, 10-year mortality rates of 10% Hydatid Cyst of the Liver. [learningradiology.com]
Prognosis mainly depends on the type of infestation (ie, whether it is cystic [CE] or alveolar echinococcosis [AE]). In CE, the prognosis is generally good, and complete cure is possible with total surgical excision without spillage. [emedicine.medscape.com]
Hepatic cysts are known to occur as the result of a genetic etiology, that is, polycystic liver disease. Polycystic means there are multiple cysts, thus, some individuals experience many hepatic cysts. [livestrong.com]
Management of Chronic Peripheral Arterial Occlusive Disease 1811 Visceral Artery Occlusive Disease Mesenteric Occlusive Disease 1827 Acute Arterial Occlusions 1837 Venous and Lymphatic Disease 1847 Vascular Access for Hemodialysis 1861 The Diabetic Foot Epidemiology [books.google.de]
Still, the combination of ultrasound technique and confirmatory serology represents a standard approach for epidemiological and clinical surveys. In unclear cases, diagnostic puncture of the cyst is performed by an experienced examiner. [news-medical.net]
International classification of ultrasound images in cystic echinococcosis for application in clinical and field epidemiological settings. Acta Trop [online] 2003 Feb, 85(2):253-61 [viewed 12 September 2016] Available from: 6. [clinicalsenseapp.com]
[Crossref] Eckert J, Deplazes P (2004) Biological, epidemiological, and clinical aspects of echinococcosis, a zoonosis of increasing concern. Clin Microbiol Rev 17: 107-135. [oatext.com]
Biology and epidemiology Hydatidosis, a zoonotic infection, is due to the larval stage of the tapeworm Echinococcus (E.). Two of the recognised species, E. granulosus and E. multilocularis, are of importance for humans. [ncbi.nlm.nih.gov]
Liver failure after partial hepatic resection: Definition, pathophysiology, risk factors and treatment. Liver Int 2008;28:767-80. 10. Kabaalioðlu A, Ceken K, Alimoglu E, Apaydin A. [ijri.org]
These three nutrients are critical for helping to prevent cysts anywhere in the body. Very few people get enough of these nutrients in their diet, which is probably one explanation for why cysts are so common now. [liverdoctor.com]
International Journal of Preventive Medicine. 2012; 3(9): 660-663 [Pubmed] 18 Re: Di Benedetto et al.: Isolated large hydatid cyst in the kidney of an elderly man (Urology 2012;79:e47-e48) Iaria, C. and Pernice, L.M. and Forino, D. and Barberi, G. and [saudijgastro.com]
The most effective preventive intervention against cystic echinococcosis is a combination of dog antihelminthic treatment and sheep vaccination. [news-medical.net]
Prevention The key issue in hydatidosis is prevention. Anthelmintic treatment of farm dogs remains currently the best way to reduce the prevalence of the disease. [ncbi.nlm.nih.gov]
The effect of albendazole on the prevention of secondary hydatidosis. Hepatogastroenterology [online] 2000 Jan-Feb, 47(31):247-50 [viewed 12 September 2016] Available from: 14. [clinicalsenseapp.com]
- Eckert J, Deplazes P. Biological, Epidemiological, and Clinical Aspects of Echinococcosis, a Zoonosis of Increasing Concern. Clin Microbiol Rev. 2004;17(1):107-135.
- Nunnari G, Pinzone MR, Gruttadauria S, et al. Hepatic echinococcosis: Clinical and therapeutic aspects. World J Gastroenterol. 2012;18(13):1448-1458.
- Liu W, Delabrousse É, Blagosklonov O, et al. Innovation in hepatic alveolar echinococcosis imaging: best use of old tools, and necessary evaluation of new ones. Parasite. 2014;21:74.
- Farrokh D, Zandi B, Pezeshki Rad M, Tavakoli M. Hepatic alveolar echinococcosis. Arch Iran Med. 2015;18(3):199-202.
- Mihmanli M, Idiz UO, Kaya C, et al. Current status of diagnosis and treatment of hepatic echinococcosis. World J Hepatol. 2016;8(28):1169-1181.
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- Murray PR, Rosenthal KS, Pfaller MA. Medical Microbiology. Seventh edition. Philadelphia: Elsevier/Saunders; 2013.